The Supreme Court on Wednesday refused to let the Trump administration immediately enforce new medical restrictions for transgender people in federal prison, leaving a lower court's block on the policy in place.
Justices Samuel Alito and Clarence Thomas said they would have allowed enforcement. The policy followed an executive order from President Donald Trump, who has taken several steps to roll back transgender rights in his second term.
What the policy would do
The order told the Bureau of Prisons to rewrite its medical rules so federal money is not spent for the purpose of making an inmate's appearance match that of the opposite sex. Under the policy, surgeries would stop, hormone treatments would be tapered off, and social accommodations such as makeup and wigs would end. Mental health services would continue.
Attorneys for transgender inmates challenged the rules. US District Judge Royce Lamberth, nominated by President Ronald Reagan, ordered that treatments continue. He noted that untreated gender dysphoria can cause severe depression, anxiety and suicidal thoughts.
The administration appealed, arguing the treatments raised security concerns and could no longer be justified. A divided appeals court panel kept Lamberth's order in place, and the Supreme Court has now declined to disturb it while the case moves forward.
About 600 patients
About 600 inmates were receiving hormone therapy in 2025, the bureau said in court records. Lawyers for the prisoners said withdrawing care would have serious effects on their bodies and mental health. They also wrote that the government has not detailed evidence of security problems linked to hormone therapy over the 30 years it has been provided.
The court has moved the other way on some related policies. It has allowed restrictions on transgender military service and on sex markers on passports to proceed for now.
Where the case goes
Wednesday's order is not a final ruling on whether the policy is lawful. It only keeps the district court's block in force while the appeal continues, meaning the roughly 600 inmates keep their current treatment for now.